Coates Matthew D, Soriano Christopher, Dalessio Shannon, Stuart August, Walter Vonn, Koltun Walter, Bernasko Nana, Tinsley Andrew, Clarke Kofi, Williams Emmanuelle D
Department of Medicine, Division of Gastroenterology and Hepatology (Matthew D. Coates, Shannon Dalessio, August Stuart, Nana Bernasko, Andrew Tinsley, Kofi Clarke, Emmanuelle D. Williams).
Department of Medicine (Christopher Soriano).
Ann Gastroenterol. 2020 Jan-Feb;33(1):45-52. doi: 10.20524/aog.2019.0442. Epub 2019 Nov 29.
Pain perception is critical for detection of noxious bodily insults. Gastrointestinal hypoalgesia in inflammatory bowel disease (IBD) is a poorly understood phenomenon previously linked to poor patient outcomes. We aimed to evaluate the risk factors associated with this condition and to discern characteristics that might differentiate these patients from pain-free quiescent counterparts.
We performed a retrospective analysis using an IBD natural history registry based in a single tertiary care referral center. We compared demographic and clinical features in 3 patient cohorts defined using data from simultaneous pain surveys and ileocolonoscopy: a) active IBD without pain (hypoalgesic IBD); b) active IBD with pain; and c) inactive IBD without pain.
One hundred fifty-three IBD patients had active disease and 43 (28.1%) exhibited hypoalgesia. Hypoalgesic IBD patients were more likely to develop non-perianal fistulae (P=0.03). On logistic regression analysis, hypoalgesic IBD was independently associated with male sex, advancing age and mesalamine use, and inversely associated with anxious/depressed state and opiate use. Hypoalgesic IBD patients were demographically and clinically similar to the pain-free quiescent IBD cohort (n=59). Platelet count and C-reactive protein were more likely to be pathologically elevated in hypoalgesic IBD (P=0.03), though >25% did not exhibit elevated inflammatory markers.
Hypoalgesia is common in IBD, particularly in male and older individuals, and is associated with an increased incidence of fistulae and corticosteroid use. Novel noninvasive diagnostic tools are needed to screen for this population, as inflammatory markers are not always elevated.
疼痛感知对于检测有害的身体损伤至关重要。炎症性肠病（IBD）中的胃肠道痛觉减退是一种尚未被充分理解的现象，此前与患者预后不良有关。我们旨在评估与这种情况相关的危险因素，并识别可能将这些患者与无痛静止期患者区分开来的特征。
我们使用位于单一三级医疗转诊中心的IBD自然病史登记处进行了一项回顾性分析。我们比较了根据同时进行的疼痛调查和回结肠镜检查数据定义的3个患者队列的人口统计学和临床特征：a）无疼痛的活动性IBD（痛觉减退性IBD）；b）有疼痛的活动性IBD；c）无疼痛的非活动性IBD。
153例IBD患者患有活动性疾病，43例（28.1%）表现出痛觉减退。痛觉减退性IBD患者更有可能发生非肛周瘘管（P=0.03）。逻辑回归分析显示，痛觉减退性IBD与男性、年龄增长和使用美沙拉嗪独立相关，与焦虑/抑郁状态和使用阿片类药物呈负相关。痛觉减退性IBD患者在人口统计学和临床上与无痛静止期IBD队列（n=59）相似。痛觉减退性IBD患者的血小板计数和C反应蛋白更有可能出现病理性升高（P=0.03），尽管超过25%的患者炎症标志物未升高。
痛觉减退在IBD中很常见，尤其是在男性和老年人中，并且与瘘管发生率增加和使用皮质类固醇有关。由于炎症标志物并非总是升高，因此需要新的非侵入性诊断工具来筛查这一人群。
